Perception of the Attributes of Safe Healthcare by Nurses

Introduction

International organizations and professional associations are initiators of projects to stabilize and improve the quality of patient care safety in clinical settings. They focus on error prevention, risk minimization, and reducing the occurrence of adverse events during healthcare provision. The results of these projects repeatedly confirm the close relationship between nurses' work environments, staffing levels, and care quality (Papathanasiou, Zoukou, Dimitriou (2024). Cartaxo, Mayer, Eberl, Bergmann (2024) view the attributes of safe healthcare as a systemic problem of healthcare institutions. Safe care means that it is organized and provided without threatening patients’ physical, mental, social, or economic safety. Measures aimed at promoting safety must be measurable. The goal is to prevent systemic errors. This state is possible to achieve when implemented correctly and at the right time (Hulková, Kilíková, 2026). In this context, the issue of nurses' perception of the attributes of safe healthcare is highly relevant. It reflects societal needs in healthcare funding. Simočkova and Pentraková (2018) report that 71% of nurses perceive safety positively. Nevertheless, they recommend giving more attention to this issue during study and in continuous education programs. Abawaji et al. (2025) report that completing an annual educational module on safe healthcare confirmed a significant improvement in awareness of the importance of safety issues. Experts suggest this is a systemic problem concerning the educational environment and it can influence the formation of professional attitudes of future nurses. According to Wang, Dong et al. (2021), collecting evidence on the perception of safe healthcare is important because it underpins the development and implementation of strategies to improve it. They state that although nurses perceive safe care positively and have good knowledge, they apply it in practice only in a limited way.

Aim

To identify nurses' perception of the attributes of safe healthcare.

Sample and Methods

The study sample consisted of 411 purposively selected nurses. The selection criterion was the practice of the nursing profession and consent to be included in the sample. The demographic characteristics (Table 1) confirm a strong representation of nurses aged 36–50 years (37.5%). More than 20 years of practice was reported by 43.1% of nurses.

Table 1. Sample characteristics by age and years of practice

Legend: N = absolute number, NR = relative number

To assess the perception of the attributes of safe healthcare, we used a self-developed questionnaire. We distributed 560 questionnaires. The return rate was 73.39%. Nurses’ responses were rated on a 5-point Likert scale. A value of 1 means strongly disagree, 2 means disagree, 3 means neither agree nor disagree, 4 means agree, and 5 means strongly agree. The questionnaire monitored perceptions of 13 attributes of healthcare safety. We verified the accuracy and reliability of the questionnaire using Cronbach's alpha coefficient. Ordinal variables were analyzed using nonparametric statistical tests—Friedman’s analysis of variance. The practical significance of the statistical test results was tested as Kendall’s W. We determined the mean ranks of the studied attributes of safe care.

Results and Discussion

There is a statistically significant difference in nurses’ perception of individual attributes of safe healthcare χ2(10) = 326,723, p < ,001. The mean rank of attributes (Table 2) shows positive perception in the attribute of managing acute states (MR = 6.80), preventing patient mix-ups, procedures, and sides (MR = 6.72), and preventing healthcare-associated infections (MR = 6.64). Lower perception scores were found for the attributes of respecting patients’ rights (MR = 4.58) and supporting mobility (MR = 4.81).

Table 2 Perception of attributes of safe healthcare

Legend: AM – arithmetic mean, MR – mean rank, Med – median, SD – standard deviation, χ2 – Friedman analysis of variance, df – degrees of freedom, p – significance level, W – Kendall's W as an indicator of practical significance

Device technology plays a high priority role in managing emergency situations, and its failure could have fatal consequences for the patient. Modern technologies improve healthcare, reduce costs, and determine the safety of care. From a healthcare safety perspective, fully functioning, reliable medical technology is essential for managing urgent conditions. Powel-Cope et al. (2012) state that there are about 5,000 types of medical devices and equipment in healthcare systems. They are at risk of loss of function and subsequent patient harm. Their failure, for example during resuscitation or ventilation, would mean immediate danger to a patient’s life. Rodziewicz et al. (2022) argue that healthcare safety can be maximized by implementing preventive measures. As preventive interventions, they consider setting maintenance processes for medical equipment and preventive staff training. They attach importance to continuous monitoring of devices and reporting adverse events related to this safety attribute. Perception of the attribute concerning prevention of patient mix-ups, side and procedure errors (MR = 6,72) confirms the importance of standardizing this area of safety. Similar findings were published by Romano et al. (2021). They report that Italy also has recommendations focused on correct patient identification, surgical site, and procedure itself. Sheedy and Richard (2020) see some reservations in safe identification, noting that not many studies have been published in this area. They estimate the number of operations on the wrong site between 0.0 and 4.5 per 10,000 operations. They state that involving patients in the identification process before surgery would represent progress in healthcare safety. Rodziewicz, Houseman, Hipskind (2022) found that this safety mechanism is in the use of a so-called checklist. Practice experts attach importance to standardizing procedures. Healthcare-associated infections are a risk of morbidity, mortality, and financial burden on health systems. They affect 3% of all hospitalized patients in the United States, 6.5% in the European Union, and global prevalence is probably higher (Sikora, Zahra, 2021). The most common healthcare-associated infections include urinary tract infections, surgical wound infections, ventilator-associated pneumonia, and bloodstream catheter infections. This area of safe care has its critical points. Čurová, Toporová, Krůtová et al. (2022) point to the need to set effective preventive measures focused on strict hygiene by healthcare workers, surface disinfection, and targeted antimicrobial therapy for healthcare-associated infections. Lower rank scores of perception were identified in the attribute of respecting patients’ rights (AM = 4.58). According to Olejarczyk and Young (2024), successful healthcare is conditioned on adherence to a set of ethical principles, including patient autonomy. Benevolence, justice, a confidential relationship between patient and healthcare worker, and the inviolability of human life are considered elements of safe care. Perception of this attribute could be better if healthcare providers set up processes to support patients’ rights. This model is proposed by Sperling and Pikkel (2020). They state that a hospital is an institution responsible for setting processes that support the rights of patients and their families. Subjective perception of the importance of attributes of safe care is always open to debate. Unexplored areas remain that require deeper scientific study and statistical analysis. In light of our results from the sample of 411 nurses, we recommend discussing standardized strategies for managing safe care attributes. Compare study results in order to design optimal measures to prevent discrepancies. Implement evidence-based safe care procedures and ensure continuous monitoring of their impact on patient health. Among healthcare workers, this is an ongoing process of becoming aware of and identifying with the philosophy of high-priority care safety.

Conclusion

The safety of healthcare is an issue whose resolution is conditioned by protecting patients from harm. Knowledge of the topic, the ability to orient oneself in the issue, and the state of perception predict care practices in clinical practice. The attributes of safe care can be considered categorical variables. Studying their state in real practice is a high priority and necessity. Only evidence that compares perception with reality can be considered an objective picture and feedback on the state of safe care. We agree with Palese (2025), who points to the need to move from mere safety mapping to deeper study of causes and mechanisms of its emergence. The author also points out the methodological limitations of self-assessment questionnaires and recommends using mixed research approaches, including direct observation in clinical practice.

Authors: prof. PhDr. Mária Kilíková, PhD., MPH
VŠZ a SP sv. Alžbety v Bratislave, n.o., Detašované pracovisko bl. Sáry Salkaházi v Rožňave
ORCID: 0000-0001-5248-835X

PhDr. Ľubomíra KAROĽOVÁ, PhD.
VŠZ a SP sv. Alžbety v Bratislave, n.o., Detašované pracovisko bl. Sáry Salkaházi v Rožňave

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